MEDICARE: DR. THU THI CAI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	002515	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	716233	OTHER	CT	CONNECTICARE

General Provider Information

NPI Number	:	1497896963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THU THI CAI O.D.

Provider Business Mailing Address
First Line	:	477 CONNECTICUT BLVD 102
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	860-289-4848
Fax Number	:	860-289-3798

Provider Business Practice Location Address
First Line	:	477 CONNECTICUT BLVD STE 102
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	860-289-4848
Fax Number	:	860-289-3798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	09/20/2016

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